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Introduction: There is emerging data for safety and efficacy of graded challenges to penicillin (GCP), without penicillin skin testing, in patients with low risk reaction histories. We describe outcomes of GCP in ICU patients. Method(s): From 8/2021 to 6/2022, allergy/immunology physicians completed e-consults for ICU patients with a penicillin allergy label. Low risk history was defined as unknown reaction or a history of a cutaneous-only reaction >5 years ago and was verified by chart review or patient/family contact. GCP consisted of a 2-3 step challenge to amoxicillin or ampicillin. Patient demographics, GCP results, pre/post GCP antibiotics regimens, and a 2-4 week follow up were collected. Result(s): There were 40 ICU patients with low-risk reaction histories. Historical reactions included: rash (17, 43%), hives (10, 25%), angioedema (5, 13%), and unknown (8, 20%). The median age was 63.5 years (interquartile range: 58.8- 72.3). Patient characteristics included: 24/40 patients (60%) intubated, 12/40 (30%) receiving steroids, 10/40 (25%) COVID-19+, 8/40 (20%) receiving vasopressors, 7/40 (18%) on antihistamines, and 1/40 (3%) on ECMO. A total of 32/40 (80%) patients underwent GCP. There was a negative GCP in 31/32 (97%) patients;one patient developed self-limited abdominal pain. Twelve of 32 (38%) patients transitioned to penicillins: from cephalosporins (10/12), vancomycin (3/12), metronidazole (1/12), meropenem (1/12), macrolide (1/12). There were 15/40 (37.5%) deaths at 2-4 weeks follow up. Conclusion(s): : GCP was safe and efficacious in critically ill ICU patients with low risk reaction histories. Given the high ICU mortality, patients should be carefully identified for GCP. Copyright © 2022
ABSTRACT
Research in second language learning has identified the absence of metacognition among learners as one of the major problems contributing to students’ inability to comprehend listening texts. Moreover, the shift to remote teaching due to COVID-19 has made it more crucial for teachers and learners to adapt to new modes of teaching and learning. This accentuates the need for effective listening strategy instruction. This study conducted at a university in Oman, is unique in two ways: first, it seeks out teachers’ perceptions of metacognitive strategy instruction in remote teaching;and second, the intervention in the form of explicit metacognitive strategy instruction is offered online. This paper presents the findings of the study, which focused on the following: teachers’ perception of students’ listening difficulties;teachers’ perceptions of metacognitive strategies and their explicit instruction;the role of metacognitive strategy awareness and instruction in improving student participation and skills in listening;challenges encountered in teaching listening during remote teaching;and overcoming challenges of teaching metacognitive strategies in remote teaching. This mixed-method study collected data through questionnaires and interviews with 10 faculty members and 75 students. The findings show that teachers face several challenges, such as time limitations, shortened semesters, unfamiliar coursebook contexts, and assessment practices. For strategy instruction, teachers utilized collaborative lesson planning and resources and virtual flipped classrooms, among others. We conclude that metacognitive strategy instruction can provide better scaffolding during listening instruction and recommends further exploration of students’ use of metacognitive strategies in other academic contexts. ©Authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
ABSTRACT
Background: The defective immune system in plasma cell dyscrasia places patients at a higher risk of developing a severe infection, which is one of the leading causes of death in such patients. In an era of a global pandemic, it is essential to protect them against COVID-19, but fewer effective plasma cells lead to a suboptimal response to vaccines. There is still a lack of evidence whether the seroconversion is truly clinically relevant and if patients with plasma cell disorders would benefit from frequent boosters to maintain antibody levels. Methods: Online databases including PubMed, CINAHL, Ovid, and Cochrane were searched (January 11th, 2022), following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Only articles published in the English language were included. s, case reports, and case series were excluded. Out of 40 studies, 5 articles were selected for a systematic review. Results: In all 5 studies (N=654), seroconversion post-vaccination was used as a positive response to COVID-19 vaccination. Although patients with plasma cell disorders had a lower seroconversion rate compared to controls, the overall percentage was substantial and ranged between 23-95.5%. Amongst patients on active therapy, lower seroconversion rates were seen in patients on a CD-38 inhibitor, ranging from 20.2-92.1% (N=174). Also, a significantly lower percentage was recorded in patients above 65 years and those who have been treated with multiple therapies previously. Better seroconversion rates were seen in mRNA vaccines compared to J&J. Conclusions: Variable seropositive rates are seen in patients with plasma cell dyscrasias, lower rates are reported in patients on active therapy, CD-38 targeting therapy, and elderly patients. Hence, these patients should receive a 4 shot series.
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Background: With reference to the National vaccination drive against COVID-19 disease (rolled out on January 16, 2021 by Government of India), this study was undertaken to analyze the patterns of antibody response among fully vaccinated adult individuals, to find the spectrum of adverse events following immunizations and knowledge component of the participants regarding the COVID-19 vaccines as well as its side effects. Materials and Methods: A total of 500 vaccinated individuals (with two doses of Government approved Covishield vaccine) were studied over a period of 9 weeks following the second dose of their vaccine. They were tested for the development of antibodies against SARS-CoV-2 spike protein, using an immunoglobulin G ELISA kit on three occasions, and the seroconversion pattern was analyzed. Results: A postvaccination seroconversion rate of 63.8% (at 2-3 weeks), 83.2% (at 4-5 weeks), and 93.2% (overall seroconversion rate at 8-9 weeks) was found. While 77.4% participants (at 4 weeks) and 65.9% participants (at 8 weeks) showed rise in optical density (OD) values, 7.4% showed a declining in OD values (at 8 weeks) and 6.8% remained seronegative throughout the study period. Sixty-two percent had experienced at least one form of adverse effect postvaccination, which were mostly mild in nature not requiring hospitalization. Conclusion: This study found that the timeline for seroconversion postvaccination by COVISHIELD varies between individuals, with few showing decline in the OD values as well and that majority of the adverse reactions observed in this population were only mild and manageable not requiring hospitalization.